Shopping for Drugs

Studies | Health

No. 262
Monday, June 02, 2003
by Devon Herrick


Notes

  1. Prescription drug expenditures were $121.5 billion in 2000, $141.6 billion in 2001 and an estimated $160.7 billion in 2002. See "Prescription Drug Expenditures Aggregate and per Capita Amounts, Percent Distribution and Average Annual Percent Change by Source of Funds: Selected Calendar Years 1980-2012" (Table 11), National Health Care Expenditures Projections, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, January 2003. Also see Kathleen D. Jaeger, "Drug Pricing & Consumer Costs," Presentation to the U.S. Senate Commerce Committee, April 23, 2002; and "Fact Sheet: The Use of Over-the-Counter Medicines," National Council on Patient Information and Education, January 2002.
  2. National Center for Health Statistics, cited in "Many Patients Receiving Medication," USA Today Snapshots, USA Today, January 31 - February 2, 2003.
  3. Frank Lichtenberg, "Benefits and Costs of Newer Drugs: An Update," Working Paper No. 8996, June 2002, National Bureau of Economic Research.
  4. "2002 Missouri Prescription Drug Pricing Survey," Public Issue Management, 2002.
  5. Although some of the following anecdotes are from regional surveys conducted by the news media, the results are consistent with a recent multi-state survey by a research institute. See RetireSafe.org, "Take the Rx Challenge: 2003 Retail Pharmacy Pricing Survey," June 2003, Council for Government Reform.
  6. Barbara West, "Massive Mark-Ups Found on Generic Drugs," WFTV9, October 21, 2002.
  7. Becky Thompson, "Generic Prescription Prices," WPXI-TV (realpittsburgh.com), November 4, 2002.
  8. West, "Massive Mark-Ups Found on Generic Drugs."
  9. Chris Koeberl, "The I-Team Investigates Pricing of Generic Drugs," KWCH 12 Eyewitness News (KWCH.com), December 18, 2002.
  10. Kathy Times, "Independents Often Beat Chains in Prescription Prices," NBC13.com, November 25, 2002.
  11. Sample was taken on June 16, 2003.
  12. Philip B. Gorelick, "Aspirin and Ticlopidine for Prevention of Recurrent Stroke in Black Patients," Journal of the American Medical Association, June 11, 2003, pages 2,947-57.
  13. Price comparison was obtained from DestinationRX.com. A patient taking two (250mg) tablets per day purchased in quantity (e.g., 100 tablets) at RXUSA.com would spend $59.31 per month compared to $98.15 at Costco.com.
  14. First-generation antihistamines also include Clistin (Carbinoxamine), Tavist (Clemastine), Chlor-Trimeton (Chlorpheniramine) and Dimetane (Brompheniramine).
  15. Philipp S. Muether and Jack M. Gwaltney Jr., "Variant Effect of First- And Second-Generation Antihistamines as Clues to Their Mechanism of Action on the Sneeze Reflex in the Common Cold," Clinical Infectious Diseases, November 1, 2001, pages 1,483-88.
  16. "Newer Antihistamines," Medical Letter, April 30, 2001.
  17. Comparison capsules are Zyrtec 10mg and Clarinex 5mg at Eckerd.com.
  18. Loratadine was priced in boxes of 20 tablets at Walgreens.com for $12.99 per box.
  19. Loratadine, sold under the trade name Alavert, is also available in 48-count boxes at Wal-Mart for about $24, for a cost per tablet of about $0.50. Diphenhydramine is available at Drugstore.com for about $12 per 100 tablets, or 12 cents per tablet.
  20. At Drugstore.com, 100 doses of Allegra sells for $123.32.
  21. Gardiner Harris, "F.D.A. Approves Over-Counter Sales of Top Ulcer Drug," New York Times, June 21, 2003.
  22. Purchasing 100 doses of Prilosec (30 capsules at a time) from Walgreens.com costs $409.97.
  23. Purchasing in quantities of 30 capsules would save almost $0.73 per pill while purchasing in larger quantities would save greater sums.
  24. Histamine H 2-receptor antagonists also includes Pepcid (Famotidine) and Tagamet (Cimetidine).
  25. Ranitidine is available over the counter in 75mg tablets but is often prescribed in 150mg or even 300mg doses.
  26. In this example, purchasing 100 150mg doses would require buying 200 75mg tablets and taking two at a time. This is often more economical than purchasing the 150mg prescription strength.
  27. Purchased in quantities of 100 40mg tablets for $75 per 100 40mg tablets.
  28. Gardiner Harris, "F.D.A. Approves Over-Counter Sales of Top Ulcer Drug," New York Times, June 21, 2003. The OTC version of Prilosec is expected in fall 2003, selling for about $1 per capsule.
  29. Amanda Gardner, "How to Break a Blockbuster Drug in Half: Man Invents Device to Cut Odd-Shaped Viagra Pill," HealthScoutNews, December 5, 2002.
  30. Tara Parker-Pope, "An Easy Remedy: Cut Your Drug Bills in Half by Cutting Pills in Half," Wall Street Journal, July 27, 2001.
  31. Randal S. Stafford and David C. Radley, "The Potential of Pill Splitting to Achieve Cost Savings," American Journal of Managed Care, August 2002, pages 706-12.
  32. Susan J. Landers, "11 Pills Score as Candidates for Splitting," American Medical News, September 23/30, 2002.
  33. "Bitter Pill: The Rising Prices of Prescription Drugs for Older Americans," Publication No. 02-104, June 2002, Families USA.
  34. William M. Welch, "VA Offers Medicines at Bargain Prices," USA Today, June 18, 2003.
  35. Aidan Hollis, "Closing the FDA's Orange Book," Regulation, Winter 2001.
  36. Milt Freudenheim (New York Times News Service), "Prices of Generic Drugs Rising Much Faster than Brand-Name Counterparts'" Naples Daily News, December 27, 2002.
  37. "Maximizing the Drug Lifecycle," Research Reports, Reuters Business Insight, August 2001.
  38. Prescription drug expenditures were $121.8 billion in 2000. See Jaeger, "Drug Pricing & Consumer Costs."
  39. Chris Adams, "Pharmaceuticals Industry Blasts Bush's Bid to Eases Generic Rules," Wall Street Journal, December 26, 2002.
  40. Leila Abboud, "Bush Acts to Speed Generics to Market," Wall Street Journal, June 12, 2003, page A3.
  41. "Fact Sheet: The Use of Over-the-Counter Medicines," National Council on Patient Information and Education, January 2002.
  42. Harris Interactive, "Attitudes and Beliefs about the Use of Over-the-Counter Medicines: A Dose of Reality," National Council on Patient Information and Education (NCPIE), January 2002.
  43. Martin S. Lipsky and Theresa Waters, "The 'Prescription-to-OTC Switch' Movement: Its Effects on Antifungal Vaginitis Preparations," Archives of Family Medicine, July/August 1999, pages 297-300. However, the Consumer Healthcare Products Association (CHPA) claims 700 OTC medications were available only by prescription 30 years ago.
  44. For a discussion of the process the FDA follows in approving a drug's move from prescription to OTC, as well as a list of classes of medications available OTC, see Lori R. Jacobs, "Prescription to Over-the-Counter Drug Reclassification," American Family Physician, May 1, 1998.
  45. Gaye Perry and Peter Mansell, "Rx-to-OTC Switching: The Way Forward for the Global Pharmaceutical Industry?" research report, Urch Publishing Ltd., September 2000.
  46. Holly M. Spencer, "The Rx-to-OTC Switch of Claritin, Allegra, and Zyrtec: An Unprecedented FDA Response to Petitioners and the Protection of Public Health," American University Law Review, pages 999-1,050.
  47. Amy K. Erickson, "Rx-to-OTC Switches Offer Golden Opportunity," Pharmacy Today, 2002.
  48. "OTC Prilosec One Step Closer in US," Pharmafocus News, June 26, 2002; "Prilosec OTC Launch Delayed, Pharmafocus News, November 4, 2002.
  49. Gardiner Harris, "F.D.A. Approves Over-Counter Sales of Top Ulcer Drug, New York Times, June 21, 2003.
  50. Erickson, "Rx-to-OTC Switches Offer Golden Opportunity." New York Times, June 21, 2003. "Drugstore.com is taking advanced orders for OTC Prilosec at a price of $29.99 per box of 42."
  51. The prices of H2 antagonists fell by two-thirds after they were switched to OTC status. See Gail D. Newton et al., "New OTC Drugs and Devices 2001: A Selective Review," Journal of the American Pharmaceutical Association, 2002, pages 267-77.
  52. "OTC Claritin to Hit Markets by Mid-December," FDAnews Daily Bulletin, FDAnews.com, December 3, 2002.
  53. Correspondence from Thomas S. Paul, chief pharmacy officer for Ovations (United Health Group) which administers AARP's pharmacy program.
  54. Diane West, "Mail-Order Rx Chips Away at Retail Sales, Drug Store News, May 20, 2002.
  55. David Gratzer and Neil Seeman, "Granny Goes North: The Truth about Canada and Prescription Drugs," National Review, May 22, 2000.
  56. "Canadian Pharmacies," Drugstore News, December 16, 2002.
  57. Bernard S. Bloom and Ronald C. Iannacone, "Internet Availability of Prescription Pharmaceuticals to the Public," Annals of Internal Medicine, December 7, 1999, pages 830-33.
  58. Sample was of 45 Internet pharmacy Web sites claiming to be Canadian. See "An Analysis of Terrorist Threats to America's Medicine Supply," GlobalOptions, Inc., May 22, 2003.
  59. See, for example, William K. Hubbard, Senior Associate Commissioner for Policy, Planning and Legislation, Food and Drug Administration, "Continuing Concerns over Imported Pharmaceuticals, " Testimony before the Subcommittee on Oversight and Investigations, U.S. House Committee on Energy and Commerce, June 7, 2001.
  60. Michael F. Conlan, "How Safe Is the Drug Supply?" Drug Topics, October 15, 2001.
  61. Ibid.
  62. Ibid.
  63. "Are Bogus Rxs from Abroad Killing Americans?" Drug Topics, June 19, 2000.
  64. Association of International Pharmaceutical Manufacturers, "Counterfeit Medicines Rise to 12 Percent of Total Russian Market," Press Release, Association of International Pharmaceutical Manufacturers, April 25, 2002.
  65. Bernard A. Olsen, "Screening for Counterfeit Drugs Using Near-Infrared Spectroscopy," Pharmaceutical Technology, June 2002.
  66. Judy Chi, "Experts Give Clues on How to Stay Clear of Counterfeit Drugs," Drug Topics, May 6, 2002.
  67. In 2000, about $7.9 billion drugs were distributed free as samples. This is about half of the $15.7 billion the pharmaceutical industry spent on marketing in 2000. For a critical article on many of the drug industry's marketing efforts, see Jeff Gammage and Karl Stark, "Under the Influence," Philadelphia Inquirer, March 9, 2002.
  68. Between one-quarter to one-half of patients who had requested a drug sample ultimately filled a prescription of the sampled drug.
  69. "An Ample Sample?" American Medical News, October 16, 2000.
  70. Many clinics and university teaching hospitals no longer use free samples. They claim that, in the long run it is cheaper to prescribe (and purchase) generic medications than offer patients free samples of expensive medications that often must be refilled at significant cost. See Leigh Page, "More Clinics Ban Drug Samples, Citing Cost, Safety Concerns," American Medical News, October 16, 2000. Another reason many clinics have stopped distributing free samples is because of the effort required to comply with federal regulation. See Fred Gebhart, "Pharmacists Welcome Vouchers in Place of Drug Samples," Drug Topics, January 21, 2002.
  71. For a list of discount programs for specific medications, see "Drug List," Needymeds.com, March 30, 2003, accessible at www.needymeds.com. To see if you might qualify for various programs, see http://www.helpingpatients.org.
  72. For a list of discount programs for specific medications, see "Drug List," Needymeds.com, March 30, 2003.
  73. Richard Cauchi, "State Pharmaceutical Assistance Programs," National Conference of State Legislators, June 9, 2003, accessible at http://www.ncsl.org/programs/health/drugaid.htm.
  74. Eckerd.com sells Alprazolam for just over $7.60 for a 30-day supply.

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